Jugglers and Chameleons

Shortage Busters: Build a Culture of Retention by Understanding and Supporting Your Middle Managers

By Carla Perrotta

The pervasive nursing shortage has increased the pressure on an already strained healthcare system. One group that is feeling this staffing crunch most acutely and increasingly being held accountable for staff retention is middle management.

In some cases, this pressure has worked to help increase retention levels. Yet, putting all the weight on middle managers is not a universal remedy. Tasking with this load could potentially lead to serious burnout. Administrators also need to understand how managers can help increase retention levels.

Much has been written about creating a culture of retention, one in which nurses feel needed and valued and are less inclined to leave. Numerous articles and studies illustrate the value of incorporating methods such as mentoring programs, in-service training or utilizing a healthcare staffing service in order to ease the pressure on existing employees.

Yet, for most organizations, its usually not enough to blindly implement these or other measures. What administrators need is a solid point person, somebody who has a big-picture view of the organizations overall strategic plan, yet also is aware of the daily issues that plague nurses and other healthcare staffers which, more than anything else, can cause them to leave.

This is where the middle manager comes in. These managers constantly straddle two worlds, implementing strategies devised by the higher levels of healthcare administration, while serving as the link between these higher levels and the general hospital workforce.

But in order to support middle managers in this crucial role and increase their chances of improving retention, it helps to know what they actually do.

Jugglers and Chameleons

Successful middle managers must balance many tasks and fulfill many roles on a daily basis, including:

  • Monitor: Effective managers know whats going on in their environments. Managers should never have to find out something through the grapevine. Rather, they should monitor their environments, quell rumors and solve issues before they have a chance to ripen into problems.

  • Communicator: Monitoring the environment can only take managers so far. If staff members arent talking, it can be hard to spot the issues. Therefore, managers also must be effective communicators, and develop an environment where people feel comfortable talking about their issues. By being active, supportive listeners, managers can help to address a staff members concern before it becomes a serious problem.

  • Delegator: Many talented people burn out by adopting the if you want something done right, do it yourself mentality. Good managers dont try to do everything themselves. By delegating tasks to their staffs, managers remain fresh and help to increase the output and streamline the efforts of the organization. For example, if a manager wants to revise the organizations orientation program, but doesnt even have enough time to review the existing one, he or she might try enlisting help from someone who has a vested interest in the success of the program.

  • Motivator: Delegating tasks is only half the battle. You also need staff members that will complete these assignments because they want to, not because they are asked to. Motivated staff members, who believe in what they are doing, will put in the extra effort to ensure that the job is done right.

  • Team builder: Employees have different skill sets and capabilities, and giving inappropriate tasks to staffers who are not prepared for that level of responsibility is counterproductive. An effective manager knows how to challenge employees without breaking them, and can determine whether staff members would benefit from additional training so that they can handle a greater level of responsibility. In this way, effective managers build teams that serve the organization better, while nurturing the careers of team members and making them feel needed.

  • Problem solver: Even good managers run into problems, and not every issue can be resolved before it reaches a crisis point. Healthcare is a fast-paced environment, and a situation can turn critical very quickly. But a good manager knows how to remain levelheaded under fire, address the problem, allocate the appropriate resources and reestablish equilibrium as soon as possible. Maintaining this balanced environment helps to relieve some of the pressure from nurses and other healthcare workers who may feel besieged if problems are allowed to develop and become pervasive.

  • Liaison: The size of todays healthcare systems can be daunting to nurses and other frontline staffers, who may feel they dont have a voice. Middle managers can provide this voice by actively listening to nurses concerns and representing their shared needs and issues at administrative meetings. Good managers run interference for their staff members, helping to shield them from politics and inefficient processes such as the implementation of unnecessary forms, so the nurses can focus on patient care. At the same time, when lack of resources or a conflicting strategy keeps staff members from getting what they want, a good middle manager can explain why.

  • Strategist: While mid-level managers spend many of their days keeping things running smoothly, they also should be involved in the organizations overall strategic plans. These managers have their fingers on the pulse of the organization and can offer insights into the effect that new initiatives such as renovated facilities, training programs or the implementation of information technologies will have on nurses and other staffers.

  • Leader: Above all, managers should be leaders. Healthcare workers need to believe in their superiors. When nurses feel their efforts are wasted, and that their leaders are not capable, it makes the leap to another organization, or even another field, that much easier.

Reward Those Who Reward You

Obviously, administrators ask a lot of their middle managers. The effects of being  constantly pulled in different directions and forced to change roles and adapt to new initiatives, can result in high burnout for middle management. And this can be dangerous for a healthcare organization. While managers in other industries are typically responsible for helping to protect a companys bottom line, healthcare managers also must protect lifelines the lives of patients. The stakes in healthcare are higher than in other industries, so effective managers, who help reduce risk and save the organizations reputation, should be rewarded for their efforts.

You can reward your managers in many different ways. Again, just as the success of individual retention-building initiatives will depend upon your particular environment, you also should choose your rewards based on what fits your managers the best. Here are some suggestions:

  • Financial compensation: For some managers, simply earning more, either through raises or bonuses, is enough to keep them motivated. Competitive salaries are very important for retaining any skilled employee and managers should keep track of what nurses are paid in their city or region.

  • Additional training: While its important for mid-level managers to facilitate their staff members professional development, most managers also appreciate the opportunity to advance their own skills.

  • Vacation time: Because it can be such a draining position, time off is crucial for managers, so additional vacation time can help keep them charged and motivated. Unfortunately, a common trend is for managers to not take the vacation time they already have, since they often feel that they cannot afford to leave. Keep an eye out for excessive unused vacation time. While you may appreciate the managers hard work and devotion to the organization, not taking the necessary downtime increases the persons chance of burning out.

  • Recognize efforts: Mid-level management can be a thankless job, so make sure that you offer plenty of recognition. This can involve everything from formal awards for successful programs, to simply giving managers well-deserved praise.

Keep Your Organization Humming

For many organizations, effective middle managers are the glue that help to keep the foundation workforce the nursing staff and other healthcare workers that interact directly with your patients fulfilled and can be the key to building the coveted culture of retention. In an industry that is in constant flux, having this stability can help give you an edge on your competition.

Carla Perrotta has 22 years of experience in the healthcare staffing industry and is now responsible for all business operations related to Kelly Healthcare Resources, a business unit of staffing provider Kelly Services, Inc., based in Troy, Mich. For more information, visit www.kellyhealthcare.com.


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